Relationship Between AFib, Diabetes Critical to Veteran Care

By Steven Spotswood

Valentin Fuster, MD, PhD, JACC editor-in-chief

Valentin Fuster, MD, PhD, JACC editor-in-chief

WASHINGTON—The VA treats about a million veterans for diabetes, nearly one-fourth of its patient population. 

At the same time, a recent study found that more than 40,000 veterans 75 and older were diagnosed between 2002 and 2012 with AFib, which occurs more frequently with age, and that 34% of them also were diagnosed with diabetes.1

That’s why new information on the nexus of AFib and diabetes is critically important to VA healthcare professionals.

The significance is further magnified when the research appearing in the Journal of the American College of Cardiology (JACC) suggests that the risk of ischemic stroke is even greater than previously suspected in patients with both conditions and that the length of time since diabetes was diagnosed is a more important indicator of risk than many other factors, including glucose control.2

“One of the critical questions has been what leads to the stroke in patients with atrial fibrillation and diabetes,” explained Valentin Fuster, MD, PhD, JACC editor-in-chief, in a commentary on the recent study. “Is it duration of diabetes, the intensity of treatment reflected in part by hemoglobin A1c, or is it other factors?”

The study provided the following answer to that question: For patients who have suffered from diabetes for at least three years and who also have AFib, the risk of ischemic stroke rose by about 75%. The increase was independent of the age of the patient and, in a surprising turn of events, quality of hemoglobin A1c control seemed to have no effect on the stroke risk.

Duration of diabetes might be important, according to the authors, because the longer a patient suffers from diabetes, the more likely the disease will affect blood clotting. Previous studies have found that prolonged duration of diabetes significantly increases thrombin generation, which can heighten the risk of thrombosis.

According to the authors, accounting for duration of diabetes could improve stroke risk models in patients with AFib. While presence of diabetes is currently one of the major risk factors for stroke, duration has not been taken into account.

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  1. Richard Stein, MD says:

    Sleep apnea is associated with a-fib. Sleep apnea and diabetes are both related to being overweight. The commonality is weight and that is probably why HgA1c is not associated with stroke risk, but rather the degree of sleep apnea and whether it is treated or not is the risk for stroke. I am an ophthalmologist and diagnose 40-60 patients per year with sleep apnea related to eyelid laxity. When probably diagnosed these patients feel better, and hopefully we can reduce the risk of a-fib and in those who already have a-fib reduce the risk of stroke from decrease low oxygen levels.

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